β受体阻滞剂在治疗婴幼儿先天性心脏病合并心力衰竭中的应用时机及方法探讨

The Opportunity and Method of Use of β-blockers in Treatment of the Congenital Heart Disease Complicated with Heart Failure in Children

目的：探讨β受体阻滞剂治疗左向右分流先天性心脏病合并心力衰竭的应用时机及方法。方法：2002-2007年本院心脏内科住院治疗的左向右分流先天性心脏病合并心力衰竭患儿符合标准共计71例,其中35例为对照组,采用常规抗心衰治疗;36例为治疗组在常规抗心衰治疗的基础上加用β受体阻滞剂美托洛尔（倍他乐克）,从小剂量开始逐渐加量至靶剂量,初始剂量0.2-0.5mg.k^g-1.d^-1,分两次,隔3-5d递增1次,目标剂量1-2mg.kg^-1.d^-1,长期维持。观察期12-23个月,进行对照开放性研究,观察其疗效、安全性及依从性。结果：治疗组在治疗3个月以后各项心功能指标均较对照组明显改善,随着治疗时间的延长,上述差异更加明显,治疗组在12个月内平均住院的次数及平均住院天数亦明显少于对照组。结论：β受体阻滞剂治疗左向右分流先天性心脏病合并心力衰竭疗效满意,临床应用依从性良好,不良反应少,安全性好。

Objective：To study !he application opportunity and method of β-blockers in the treatment of the left-to- right shunting congenital heart disease complicated with heart failure. Methods： 71 patients who were enrolled in this study were divided into control group and treatment group. All the 35 patients in control group were treated by routine therapy for heart failure （digitalis,diuretics and vasodilator）, while the other 36 patients in treatment group were treated hy β-blockers （metoprolo） based on routine therapy,initiating the therapy with tow dosage, titrating it and trying to achieve target dosage gradually, the initial dose was 0. 2-0. 5mg·kg^-1·d^-1 ,every 3 to 5 days the dose was increased once, and the maintenance dose was 1--2mg·kg^-1·d^-1 （given twice per day）. With the open-label method, the efficacy, the tolerability and the safety were observed for 12--23 months of the treatment in the two groups. Results： After using metoprolo for 3 months, the heart function of patients in the treatment group had remarkable advance compared with the control group. Along with treatment lime extension, the above difference became more obvious. Average days and frequency of hospitalization of every patient in treatment group were obviously less than those of control group. Conclusion：These findings suggest that β-blockers monotherapy is significantly effective ,for the left-to-right shunting congenital heart disease complicated with heart failure. It is tolerant and safe, and the adverse events is dose-dependent.